Important Information
A list of NDCs for the Diabetic supplies covered through the pharmacy program can be found on the Magellan Medicaid Administration web site at http://kentucky.fhsc.com. Please click on the Diabetic supply tab and then select the Diabetic Supply Preferred Product List. NDC numbers are required to bill diabetic supplies.
DME Update for October 20, 2010
A4206 will be allowed to be billed through the DME program if the diagnosis is not related to diabetes. The diagnosis codes that will exclude the item from DME are 250.00-250.93; 357.2 and 459.89.
This is effective 10-5-10. DMS apologizes for any confusion related to this item. If you have questions, please contact the department at 502-564-2687.
This information has been posted on the DME fee schedule revision date 10-5-10.
DME Update for October 5, 2010
Diabetic Supply FAQ's
DME Update for September 15, 2010
Diabetic supplies will continue to be processed through DME until 10/5/10 instead of the planned date of 10/1/10. First Health required additional time to provide a smooth transition. For those recipients who also have Medicare, all diabetic supplies will continue to process through your DME provider number.
Access to the Smart Sheets which contain Interqual criteria is now available on HealthNet. Please log in and go to the main page. Under the PA menu option, the user will see in the drop down box DME PA Smart Sheets. This link will take the user to the DME PA Smart Sheets where you will be able to scroll through the available sheets. After selecting the desired sheet, you may print or save to your PC. It will be in PDF format. If you have questions, please contact your provider rep at HP or contact DMS.
DME Update August 2010
With the movement of diabetic supplies (A4206, A4210, A4250, A4252, A4253, A4256, A4258, A4259, E0607 and E2100) to the pharmacy program effective 10-1-10, clarification is being provided as to Medicaid recipients who are dual eligibles. Claims for dual eligibles, those recipients who are Medicare primary, will continue to be processed through your DME provider number and not through the pharmacy program.
In a previous update for 7-1-10 for A5500-A5512, a diagnosis code was listed incorrectly. The correct diagnosis code is 357.20 and not 375.20.
DME Update July 2010
The planned move of diabetic supplies A4206 A4210, A4250, A4252, A4253, A4256, A4258, A4259, E0607 and E2100 to the pharmacy program has been delayed until 10-1-10. Please continue to process claims for the products through your DME provider number until further notice.
Effective 7-1-10
K0606 will now have an option for purchase.
Reimbursement changes effective 8-1-10:
Rental option is being end dated for the following codes: E0140, E0181, E0182, E0196, E0198, E0200, E0205, E0572, E0574, E0585, E0600, E0627-29, E0655, E0660, E0665-69, E0671-73 and E1372.
Codes utilizing a rental (RR) modifier with the exception of E0424, E0431, E0434, E0439, E0450, E0460, E0463-64, E0471-72, E0500, E0604, E0618-19, E0675, E0769, E0935, E1390-92, E1405-06, E1812, E1840, E1841, E2402, K0455, K0462 and K0738 are to be considered a purchased item after 10 consecutive months of rental. No further reimbursement will be allowed. An RREJ modifier combination denotes an item that is not purchased and will not be affected by this change.
The following codes will no longer require a prior authorization (PA) for rental and are subject to the above policy change: E0225, E0239, E0291, E0305, E0310, E0480, E0561-62, E0776, E0910-11, E0940-41, E0961, E0966-67, E0969-71, E0973-74, E0985, E0990, E1020, E1130, E1221, E2000, E2207-09, K0001, K0015, K0017-20, K0037, K0040-42, K0052, K0056, K0105 and K0195.
The following codes will require a PA if the amount is $500 and above: K0739, L4205, L4210, L7500, L7520 and L0849.
The following codes will no longer require a PA for a purchase: E0140, E0181-82, E0196, E0198, E200, E0205, E0225, E0239, E0291, E0305, E0310, E0480, E0561-62, E0572, E0574, E0585, E0600, E0627-29, E0655, E0660, E0665-69, E0671-73, E0776, E0910-11, E0940-41, E0961, E0966-67, E0969-71, E0973-74, E0978, E0980, E0985, E0990, E1014, E1020, E1130, E1221, E1372, E2000, E2207-09, E2367-69, K0001, K0015, K0017-20, K0037, K0040-42, K0052, K0056, K0105 and K0195, L0190, L0200, L0468, L0470, L0472, L0492, L0627, L1230, L1640, L1847, L1971, L2112, L2114, L2570, L2580, L3160, L3334, L3760, L3915, L4130, L5617, L5626, L5628, L5630-31, L5638, L5640, L5642, L5644, L5644, L5645, L5650, L5652-53, L5661, L5665, L5671, L5676-77, L5711-12, L5714, L5785, L5810, L5812, L5920, L5925, L5940, L5962, L5975, L5982, L5984, L5986, L6386, L6388, L6625, L6628, L6645, L6650, L6687-88, L6692, L6698, L6704, L6711, L7364, L7366, L7368, L7404, L8615 and L8695,V2625 and V2628.
K0001 will have a purchase limitation of one per five years.
The following codes will no longer require a PA but are subject to diagnosis restrictions ( 250.00-250.90, 375.20 or 459.89) and have a quantity limit of two per calendar year: A5500, A5503-08, A5510 A5512 has a limit of six per calendar year.
The following codes will be moved to the pharmacy program and will no longer be reimbursed through the DME program: A4206, A4210, A4250, A4252, A4253, A4256, A4258, A4259, E0607 and E2100. More details will be provided prior to Aug. 1, 2010 regarding this change. Please watch the DME update page for further information.
Please review 907 KAR 1:479E for other regulatory changes. A summary of the changes will be posted on the website in the next few days.
2010 DME Updates
Click on the 2010 DME Updates to review 2010 changes.
2009 DME Updates
Click on the 2009 DME Updates to review 2009 changes.
2008 DME Updates
Click on the 2008 DME Updates to review 2008 changes.
2007 DME Updates
Click on the 2007 DME Updates to review 2007 changes.
2006 DME Updates
Click on the 2006 DME Updates to review 2006 changes.
2010 Durable Medical Equipment (DME) Fee Schedules
DME Fee Schedule, revision date Dec. 2010: PDF - Excel
DME Fee Schedule, revision date Nov. 3, 2010: PDF - Excel
DME Fee Schedule, revision date Oct. 5, 2010: PDF - Excel
DME Fee Schedule, revision date July 2010: PDF - Excel
DME Fee Schedule, revision date May 2010: PDF - Excel
DME Fee Schedule, revision date Jan. 2010: PDF - Excel
2009 DME Fee Schedules
DME Fee Schedule, revision date Sept. 2009: PDF - Excel
DME Fee Schedule, revision date July 2009: PDF - Excel
DME Fee Schedule, revision date June 2009: PDF - Excel
DME Fee Schedule, revision date April 2009: PDF - Excel
DME Fee Schedule, revision date Feb. 2009: PDF - Excel
DME Fee Schedule, revision date Jan. 2009: PDF - Excel
2008 DME Fee Schedules
DME Fee Schedule, revision date Dec. 2008: PDF - Excel
DME Fee Schedule, revision date Oct. 2008: PDF - Excel
DME Fee Schedule, revision date Sept. 2008: PDF - Excel
DME Fee Schedule, revision date Aug. 2008: PDF - Excel
DMS Fee Schedule, revision date July 2008: PDF - Excel
DME Fee Schedule, revision date June 2008: PDF - Excel
DME Fee Schedule, revision date May 2008: PDF - Excel
DME Fee Schedule, revision date April 2008: PDF - Excel
DME Fee Schedule, revision date Feb. 2008: PDF - Excel
DME Fee Schedule, revision date Jan. 2008: PDF - Excel
2007 DME Fee Schedules
DME Fee Schedule, revision date Sept. 2007: PDF - Excel
DME Fee Schedule, revision date July 2007: PDF - Excel
DME Fee Schedule, revision date April 2007: Excel - PDF
DME Fee Schedule, revision date Feb. 2007: PDF - Excel
2006 DME Fee Schedules
DME Fee Schedule as of Oct. 19, 2006: PDF
New K Code Reimbursements as of Dec. 15, 2006: PDF - Excel